The presence of elastic compression stockings reduces the fluid responsiveness of patients in the operating room
Résumé
BACKGROUND: The aim of this study was to investigate whether elastic compression stockings (ECS) can affect fluid responsiveness parameters before and during passive leg raising (PLR) maneuvers. METHODS: In the operating room (OR), we performed a prospective study including patients referred for cardiac surgery. Blood pressure (BP). Delta PP, heart rate (HR), central venous pressure (CVP), stroke volume (SV) and aortic blood flow (ABF) (by esophageal doppler) were measured according to four conditions: supine position without ECS (baseline 1), lower limbs raised to an angle of 45 degrees (PLR 1), returned to the supine position with ECS (baseline 2), then a second PLR maneuver with ECS was performed (PLR 2). RESULTS: Twenty patients were included. BP, SV, ABF and CVP increased significantly. Delta PP and HR decreased during PLR 1. At baseline 2, HR and Delta PP decreased significantly compared to baseline 1. During PLR 2, increase of SV (4% [9]) and ABF (4% [9]), and the decrease of Delta PP (-19% [104]) were significantly lower than those observed at PLR 1 (7% [21] P=0.05; 9% [8] P=0.02 and -66% [40] P=0.02, respectively). Eleven patients presented a Delta PP >= 13% at baseline 1. Only 1 patient still presented a Delta PP >= 13% with ECS at baseline 2. Only 3/9 patients with an increase of ABF >= 10% and 2/11 patients with an increase of PP >= 12% during the PLR 1 presented similar results during PLR 2. CONCLUSIONS: In the OR, ECS provoke a self-fluid loading increasing ABF, decreasing Delta PP and PLR response. The presence of ECS should be considered when managing hemodynamic parameters of patients.